Healthcare Provider Details

I. General information

NPI: 1831155340
Provider Name (Legal Business Name): MELISSA HALE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W HIGH ST SUITE 112
EBENSBURG PA
15931-1506
US

IV. Provider business mailing address

170 MCCRACKEN RUN RD
DU BOIS PA
15801-3616
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-5565
  • Fax: 814-371-5678
Mailing address:
  • Phone: 814-371-5565
  • Fax: 814-371-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014826
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: